This is the seventh in a continuing series of articles on the American Diabetes Association (ADA) 60th Scientific Sessions held in San Antonio, TX, in June 2000. It covers topics related to the diabetic foot.

Foot Ulcers

Gayle E. Reiber, Seattle, WA, gave the Roger Pecoraro Lecture on the economics of lower-limb amputations in diabetes. A number of clinicians over recent decades have implemented programs leading to substantial decreases in amputations among participants in the U.S. and Europe. However, the target of a 40% decrease in amputation rates, based on these studies and set more than a decade ago, has not been met, and rates have actually increased. With the aging of the populations of the U.S. and Europe and the greater prevalence of diabetes, amputation rates and costs may increase further.

Using the Veterans Administration system and Medicare data sets in the U.S. and the Cost of Diabetes in Europe, Type 2 (CODE-2) data set, Reiber presented trends for foot ulcers. There are ∼300,000 hospitalizations annually for foot cellulitis, ulcers, and deep infections among individuals with diabetes and 400,000 hospitalizations among individuals without diabetes in the U.S. Amputation rates are increasing among patients with diabetes, while decreasing among those without diabetes. In 1999, there were ∼92,000 amputations among those with and 42,000 among those without diabetes.

There are tremendous variations among regions in the U.S. in the frequency of amputations and footwear prescriptions. However, <1% of Medicare patients in the U.S. obtained therapeutic footwear in 1995. Low-level amputations comprise 53% of the total, and this fraction has increased over recent years, suggesting improved limb preservation. Direct costs in the U.S. are ∼$17,000 for an episode of foot infection and $35,000 for a hospitalization leading to amputation. Reiber noted that reimbursement rates are well below these charges. Revascularization rates have tripled over …